Provider Demographics
NPI:1275979429
Name:LINGENFELTER, CODI DANYELL
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:DANYELL
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4313
Mailing Address - Country:US
Mailing Address - Phone:702-385-3330
Mailing Address - Fax:702-385-5519
Practice Address - Street 1:401 S MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4313
Practice Address - Country:US
Practice Address - Phone:702-385-3330
Practice Address - Fax:702-385-5519
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator